Pillay-Fuentes Lorente, VeshniNana, TrushaBlack, MarianneReubenson, GaryThomas, ReenuDramowski, AngelaBekker, AdrieDu Plessis, Nicolette MarieDemopoulos, DespinaChibabhai, Vindana2025-10-282025-10-282025-08-05Pillay-Fuentes Lorente, V., Nana, T., Black, M., et al. Paediatric colistin prescribing practices in South Africa: A clinician survey. S Afr J Infect Dis. 2025;40(1), a730. https://doi.org/10.4102/sajid.v40i1.730.2312-0053 (print)2313-1810 (online)10.4102/sajid.v40i1.730http://hdl.handle.net/2263/105002DATA AVILABILITY : The data that support the findings of this study are available on reasonable request from the corresponding author, V.P.-F.L.BACKGROUND : Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking. OBJECTIVES : To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline. METHOD : We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months. RESULTS : Of 196 participants, 71.9% (n = 141/196) completed the survey. Eighty-six respondents (n = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000–150 000) and 50 000 IU/kg/dose (IQR, 40 000–50 000), respectively. Empiric colistin use was reported by 47.2% (n = 69/146), of whom 46.3% (n = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement. CONCLUSION : This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA. CONTRIBUTION : This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.en© 2025. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.Colistimethate sodiumPolymixinAntimicrobial stewardship (AMS)ColistinMulti-drug resistant gram negative bacteriaPaediatric colistinSouth Africa (SA)Article